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06060106 CITY OF CUPERTINO d 'r"'�: • �- T'* `^"'" " ` '� BUILDING DIVISION PERMIT MCONTRACTOR INk'OT.2.Mt1.TION <a w =h BUILDING ADDRESS: SLK CONSTRUCTION PEIIMITND'O6O6O1O6 10371 RIVERCREST CT a:R'S NAME: PERMIT ISSUE DATE KAWARA MASAYOSHI 952 KENNETH AVE 06/13/2006 PHONE: SANITARY NO. CONTROL NO. (408) 206-6742 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG EI�Cf PLUMB MECH � 0 0 uOp LICENSED CONTRACT'OR'S DECLARATION lob Description 6 C 1 lercby affirm that I an lisnsed under provisions of Chapter 9(commencing t' with Section 7")of Division 3 of NC Business and Professions Code.and my licences ^�N in full forte and effaL WINDOWS AND EXTERIOR DOOR REPLACEMENT LIKE 4 LI a n z License Clus L'c.R tr, Dam Contractual ARCHITECTS DECLARATION I underwnd my Plw shift W tired u public awards JyU god Licensed Professional OWNER-BUILDER DECLARATION <2 1 hereby affirm that I an exempt from the Committees License Law far the 0 O following reason.(Saction 103 1.5,Business and Professions Code:Any city or county initiationwhichinitiation a permit mon construct niter,improvm e.demolish.or repair any uructure $15982 a;� prior m its issuance.alw requires the applicant for such Permit file a signed statement that he is licensed pursuant the provisions of On Comramri License Law(Chap¢r9 Sq.Ft. Floor Area Valuation y (commencing with Sudan 7000)of Division 3 of de Business and Professions Code)or y Nat he is exunpt therefrom and the buts for die alleged aempdom.Any violation or Section 7031.5 by any appliam far a permit subjects tion artificial m a civil pe thy of —MMr 0 U Occupancy Type ret mote Nan five hundred dollars($500). 1,a owner of the property,or my employees with wags u their sole Compensation, willdo the work and thearecmm 6 not intended oraRared Result,(Sec.7061,Business Required Inspections and Professions Code:The Contrxcm's License Law don WE apply an an owner of q P property who Wilds ter improves the.un,andwW dnessuch work hirosrdfortnrougn his own cmploycu,provided that such improvements are not intended uro@red for aide.R. however,to Wilding or improvement is sold within one year ofcompletion.the owner- ff�� pppAAA L builder will have the Wrdcn of proving Nat he did hot laid w improve fm purpose of build.u am ucW—' Aa E® 1, owner of the property, luitra vely contracting ills cna licensed um TAy—tmrs construct the project(Sec.7614.Business and Profession Code:)M Contractor's U. cause law docs nut apply to an owner of property who Wilda or impmvu thereon,and who contracts for such pmjam with a cantainor(s)licensed pursuant in the Conimetar's �ry� �lynf� Lmanftu•` se law. V N liUo ❑lamsea rept yn�s a A,P C for di is mason 'j^j Due ` �� � � ti WORKER'S COMPENSATION DECLARATION uK9'mY' 1 hde thereby aTom under penaity of perjury we of the fallowing declarations: Iham2newillmainuinaCenr3=mot Consentroulf-insum(or Wor .Compere axtion,u provided for by Section 3700 of the labor code,for thio pertorrnance of the work for which this permit is issued. ❑1 haw and will maintain Worker's Compensation Imur .an required by Section 3700 of Om tabor Code.far the perlmmancc of the work for which this permit u iuur4. My Wurkcfr Compan radon Insurance carrier and Policy number art: Cartier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisscction need nmbecamplered if the permit is(armee hundred dollars(SI00) m Ices.) • 1 certify Nat in the performance of the work for which this permit u issued.I shall not employany person in any mamsc1.1 bb osubject to the Workers'Compuuadoe La ws of Califamia Dyp EE��- �F Applicant k ---_�— NOTICE TO APPLICANT.If.after making Nu Ccnificam of Exemption,you should become subject no the Workeri Compersauan provisions of the IoM Code.you mut .J O forthwith comply with such previsions ar this permit shall W deemed rooked. z ""' CONSTRUCTION LENDING AGENCY [-•e.4 I W.by aRrm Out dere 4 a conswcdnn lending agency for the Parfonnana of > the work for which this perrnit 6 issued(Sec.X91,Civ.CJ a0 Landes',Name z Lender's Address (•)Q 1 cenify that I have rod this application and sate that the above information is - IL F correct I agree to comply with all city and county ordinances and auto laws reliving to 0O building convection,and hereby authomerepresentatives of this city to carer upon de r CLl abovomcntioncd pmfMrty ter iro,predmis fhtfuwhich e6 (We)agree to am.moicm.•n fy and kap hour less thc City of Cupcnimo against U V inc.runquadgmcnuecowinggrarating ofpcnse rest. may in any wayaarne against geld City / V z APPL CANTCof UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by:S4(24 Date SOURCE I1,�EEGULATI NS�.,� tAot_, l Re-roofs Sig>�re of ApplieanVComremr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Om suppliant or rum.Wilding occupant stat mhaadlc harerdou material de0ed by the Cupertino Municipal Code.Cheaper 9.12.and the HesIN and Safety .Section 15532(11)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes W Nu future If a roof is installed without first obtainingan inspection,I agree to remove Will as applicant or future building ace Muse .Air em sur Jeri..which P g emit hmaNnns air cmnamituna u defined by the cry Area Air Qulity Managcmcm all new materials for inspection. Disvictl ❑Yes )<No I have mad the boudeus mvcrials.quiremenu under Cheprer G95 ofthe Cslifar- nuHalthkSalmYCadc.Sxvau 25515.25533 and 25531.1 macrame dolifthe Wilding does not currently haw a invent dm it a my responsibility he notify h,oaup.,of de requirements which mart Wmet nor to caefia mo of a Ccrdre of Oceupmcy. Signature of Applicant Date «'"VAI x",3 Ownc anudori>ed Damw g All roof coverings to be Class "B"or better agent ' r. CITY OF CUPERTINO d 'r"'�: • �- T'* `^"'" " ` '� BUILDING DIVISION PERMIT MCONTRACTOR INk'OT.2.Mt1.TION <a w =h BUILDING ADDRESS: SLK CONSTRUCTION PEIIMITND'O6O6O1O6 10371 RIVERCREST CT a:R'S NAME: PERMIT ISSUE DATE KAWARA MASAYOSHI 952 KENNETH AVE 06/13/2006 PHONE: SANITARY NO. CONTROL NO. (408) 206-6742 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG EI�Cf PLUMB MECH � 0 0 uOp LICENSED CONTRACT'OR'S DECLARATION lob Description 6 C 1 lercby affirm that I an lisnsed under provisions of Chapter 9(commencing t' with Section 7")of Division 3 of NC Business and Professions Code.and my licences ^�N in full forte and effaL WINDOWS AND EXTERIOR DOOR REPLACEMENT LIKE 4 LI a n z License Clus L'c.R tr, Dam Contractual ARCHITECTS DECLARATION I underwnd my Plw shift W tired u public awards JyU god Licensed Professional OWNER-BUILDER DECLARATION <2 1 hereby affirm that I an exempt from the Committees License Law far the 0 O following reason.(Saction 103 1.5,Business and Professions Code:Any city or county initiationwhichinitiation a permit mon construct niter,improvm e.demolish.or repair any uructure $15982 a;� prior m its issuance.alw requires the applicant for such Permit file a signed statement that he is licensed pursuant the provisions of On Comramri License Law(Chap¢r9 Sq.Ft. Floor Area Valuation y (commencing with Sudan 7000)of Division 3 of de Business and Professions Code)or y Nat he is exunpt therefrom and the buts for die alleged aempdom.Any violation or Section 7031.5 by any appliam far a permit subjects tion artificial m a civil pe thy of —MMr 0 U Occupancy Type ret mote Nan five hundred dollars($500). 1,a owner of the property,or my employees with wags u their sole Compensation, willdo the work and thearecmm 6 not intended oraRared Result,(Sec.7061,Business Required Inspections and Professions Code:The Contrxcm's License Law don WE apply an an owner of q P property who Wilds ter improves the.un,andwW dnessuch work hirosrdfortnrougn his own cmploycu,provided that such improvements are not intended uro@red for aide.R. however,to Wilding or improvement is sold within one year ofcompletion.the owner- ff�� pppAAA L builder will have the Wrdcn of proving Nat he did hot laid w improve fm purpose of build.u am ucW—' Aa E® 1, owner of the property, luitra vely contracting ills cna licensed um TAy—tmrs construct the project(Sec.7614.Business and Profession Code:)M Contractor's U. cause law docs nut apply to an owner of property who Wilda or impmvu thereon,and who contracts for such pmjam with a cantainor(s)licensed pursuant in the Conimetar's �ry� �lynf� Lmanftu•` se law. V N liUo ❑lamsea rept yn�s a A,P C for di is mason 'j^j Due ` �� � � ti WORKER'S COMPENSATION DECLARATION uK9'mY' 1 hde thereby aTom under penaity of perjury we of the fallowing declarations: Iham2newillmainuinaCenr3=mot Consentroulf-insum(or Wor .Compere axtion,u provided for by Section 3700 of the labor code,for thio pertorrnance of the work for which this permit is issued. ❑1 haw and will maintain Worker's Compensation Imur .an required by Section 3700 of Om tabor Code.far the perlmmancc of the work for which this permit u iuur4. My Wurkcfr Compan radon Insurance carrier and Policy number art: Cartier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisscction need nmbecamplered if the permit is(armee hundred dollars(SI00) m Ices.) • 1 certify Nat in the performance of the work for which this permit u issued.I shall not employany person in any mamsc1.1 bb osubject to the Workers'Compuuadoe La ws of Califamia Dyp EE��- �F Applicant k ---_�— NOTICE TO APPLICANT.If.after making Nu Ccnificam of Exemption,you should become subject no the Workeri Compersauan provisions of the IoM Code.you mut .J O forthwith comply with such previsions ar this permit shall W deemed rooked. z ""' CONSTRUCTION LENDING AGENCY [-•e.4 I W.by aRrm Out dere 4 a conswcdnn lending agency for the Parfonnana of > the work for which this perrnit 6 issued(Sec.X91,Civ.CJ a0 Landes',Name z Lender's Address (•)Q 1 cenify that I have rod this application and sate that the above information is - IL F correct I agree to comply with all city and county ordinances and auto laws reliving to 0O building convection,and hereby authomerepresentatives of this city to carer upon de r CLl abovomcntioncd pmfMrty ter iro,predmis fhtfuwhich e6 (We)agree to am.moicm.•n fy and kap hour less thc City of Cupcnimo against U V inc.runquadgmcnuecowinggrarating ofpcnse rest. may in any wayaarne against geld City / V z APPL CANTCof UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by:S4(24 Date SOURCE I1,�EEGULATI NS�.,� tAot_, l Re-roofs Sig>�re of ApplieanVComremr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Om suppliant or rum.Wilding occupant stat mhaadlc harerdou material de0ed by the Cupertino Municipal Code.Cheaper 9.12.and the HesIN and Safety .Section 15532(11)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes W Nu future If a roof is installed without first obtainingan inspection,I agree to remove Will as applicant or future building ace Muse .Air em sur Jeri..which P g emit hmaNnns air cmnamituna u defined by the cry Area Air Qulity Managcmcm all new materials for inspection. Disvictl ❑Yes )<No I have mad the boudeus mvcrials.quiremenu under Cheprer G95 ofthe Cslifar- nuHalthkSalmYCadc.Sxvau 25515.25533 and 25531.1 macrame dolifthe Wilding does not currently haw a invent dm it a my responsibility he notify h,oaup.,of de requirements which mart Wmet nor to caefia mo of a Ccrdre of Oceupmcy. Signature of Applicant Date «'"VAI x",3 Ownc anudori>ed Damw g All roof coverings to be Class "B"or better agent ' r.